AbstractIndia is on the verge of an explosion of mental illnesses. In the coming few years India as a nation would need a number of psychologists and mental health professionals to help people deal with these problems. A probe was made to explore the opportunities for future mental health professionals and challenges they would face in their careers. It was noted that a number of people were suffering with mental problems and there was a serious lack of mental health professionals in India. Hospitals and schools were the places where mental health professionals could look for various opportunities. Some challenges like poor salary and absence of any licensing authorities are the biggest challenges for upcoming psychologists in their career in India.

Psychology in India: A Career with Uncertain Opportunities

BackgroundIn a big country like India with apopulation of 1.2 billion, you would expect that as many as millions of psychologists can find decent jobs. But unfortunately the picture is quite opposite. It’s very rare that you find a psychologist in a city hospital or even in the whole city. Despite various big claims, finding a proper psychologist in decent hospitals is also very uncommon. In reality most of the psychiatric facilities are accessible to the citizens of big cities only. Finding a qualified counsellor in the schools is a bit too much to ask, despite few exceptions. Every year thousands of the psychology graduates join the ever growing list of ‘educated unemployed’ in India. They include graduates, post graduates and even holding PhDs. For those who study the psychology as a subject of specialization and are looking for some serious career are still in a considerable number. A systematic probe is required to understand the relevance of psychologists/counsellors in modern India and at the same time it could be interesting to find how the psychologists, already in the practice, are doing in their careers.Epidemiographic View of Mental DisordersSystematic studies for collecting the epidemiographic data about the mental disease are limited and there is enough discrepancy among them. Such a study should collect the data about distribution of disease, frequency of disease, population at risk and various methods to address the issue.(1) It was recently reported that in previous epidemiological researches conducted from 1960 to 2009, the prevalence rates for psychiatric disorders varying from 9.5 to 370/1000 population in India.(2) In the same study the authors suspect that despite huge variations, as many as 20% of Indian population might be suffering from psychological troubles.(2) In a recent survey by National Sample Survey Organization it was reported that 1.49% of total population was suffering from various mental health issues. There was a small difference in favor of rural population which was at 1.7% as compared to their urban counterparts.(3) Problem with various epidemiological studies is that the most of the times they are selective in their choice of mental disorders. Anxiety disorders and some variants of depression generally are excluded. Further, various lesser known mental disorders are not reported as the population suffering from that and their care takers are not comfortable to call these problems as mental diseases. In a Meta analysis study authors tried to report the prevalence rates for different psychological disorders in India on the basis of ten prevalence studies. They reported that prevalence for all mental disorders together was 6.54%. Prevalence rates for schizophrenia were found to be 2.3 per 1000 while for affective disorders (depression) it was 31.2 per 1000. These numbers seem too big and scary. Further prevalence for anxiety neurosis, hysteria and mental retardation were 18.5, 4.1 and 4.2 per 1000 population respectively.(4) Here also the prevalence rate was reported higher in rural population as compared to urban. This is understandable as in rural India the facilities of psychological care are quite poor. All the mental hospitals are situated in cities and rural people are left alone on the mercy of family members. These data suggest that in a country with a population of 1.2 billion, as many as 65 million are suffering from mental diseases. This is a real big number of mental patients and a very big need of mental health professionals in India in every part of country. This data does not include individuals needing counseling and help for issues other than mental diseases.Challenges for Teenagers and ChildrenResearches in last few years have reported the prevalence of mental problems in teenagers is frightening in India. It was reported that three to nine per cent of teenagers in schools, studying in 9th standard or above and overtly healthy, meet the criteria for depression at any one time.(5) As many as 20% of teenagers in India reported a lifetime prevalence of depression. Further, more frustrating part is that 30-50% of cases were gone unnoticed by general physicians.(5) One can imagine that many more teenagers would not seek even primary medical care. The reason behind these numbers is an open secret. Indian children and adolescents are subjected to great distress by the ever growing expectations of parents and growing burden of books. The complex relationships with parents are the main source of stress instead of providing some coping skills.(6) The teenagers are anxious and insecure for their future. 5.3% of adolescents start using tobacco use as a coping method.(7) Another important issue in Indian teenagers is the taboo nature of sex education which is seldom provided. Normal attraction for opposite gender, if not guided properly leads to various unwanted events that create big stress in the lives of many people. It is the duty of parents to provide right information and control the sexual behavior of their children at the appropriate time. But lack of appropriate parental supervision and control and adolescent sexual activity has been shown in different studies.(8) Psychologists and counselor in their schools and locality can be a source of great help. They not only can listen but also provide some interventions to develop their potentials and provide safeguards against future psychological problems.Opportunities for Mental Health ProfessionalsThe prevalence data and challenges for Indian teenagers discussed above are just the very small piece of the whole jigsaw puzzle. These sufferings of the people indicate that the field of mental health is going to havea boom very soon. There are immense opportunities for trained mental health professionals in all fields. Indian schools in coming few years will be forced to employ a counsellor for their children and teachers both. The students are not only victims of stress and burden but they also don’t have a clue where this endless race of ill defined‘success’ is going to take them. Teachers are also following the same age old methodologies for teaching which does not seem to help in changing world. Teachers will be benefitted if they regularly get inputs from someone who understands the personality of children. One who understands how their cognitive development can be manipulated, bad habits can be replaced with good ones, what it takes to develop an environment without forcing the teaching and how to use the knowledge of memory, intelligence, reinforcement and punishment to maximize the students’ potentials. Here a counsellor in school is going to be of great help for both teachers and students. The researches have shown that presence of a counsellor have developed the students’ capacities helped them deal with their social, personal, educational and emotional issues effectively.(9) In India, Central Board of Secondary Education guidelines expect one school counselor will be appointed for every affiliated school, but this is less than 3% of all Indian students attending public schools.(10) And reality is that not all CBSE schools have a qualified counselor. Usually the job of counseling is trusted to some young teacher and this fellow sees this as an extra burden. Any way this tells that in coming years there will be a big requirement of qualified school counselors in all schools of India.Further more in coming few years all hospitals would be hiring psychologists. At this day the most of the hospitals don’t have any psychiatry and psychology departments. And where they have even there psychiatrists are doing the jobs of counselors and psychologists. Slowly but surely in the big cities the hospitals have started to have a counselor. Today good hospital chains have some psychologists and they are constantlylooking for some skilled and trained psychology professionals which are a rare commodity in India. Besides the hospital settings, what India is missing dearly is some psychologists running their own private counseling centers and clinics. This is the one area where the most of the psychologists are employed in the whole world. According to the APA's Center for Workforce Studies, there were 106,500 licensed psychologists in the United States in 2014, based on APA's 2012 state licensing board list.(11) There is no such data available about India but one can easily guess that such a number would be far smaller than this and as compared to population of India it would be very modest. India seriously needs a number of trained professionals with skills and courage both to come forward and act as the torchbearers. The opportunities for them would be amazing and it can ensure a bright future despite some struggle.Psychologists in India are usually absorbed in NGO’s and rehabilitation centers.Good thing is that here also possibilities are immense. The government of India and various state governments are always running some public welfare projects for orphan, widows, tribes, poor and disabled, criminals and drug addicts etc. There also, good psychology professionals can find decent jobs. But here also the problem is that there is always a disparity between job demand and qualification sought. So a psychology graduate can be in competition with one trained in literature. This doesn’t encourage the psychology graduates.ChallengesWhile it seems that there are immense opportunities for psychologists in India, one can’t help admitting the various challenges that young graduates have to come across. These challenges mostly discourage the young guys to pursue the career in psychology especially if they can look elsewhere. In reality the majority of the students enrolling in psychology courses are those who didn’t find options in other courses or in stern words were not simply goodenough to get admission in those fields that are more promising. Of course there are exceptions but those who look at the psychology as the first choice of career; they also get to face discouraging and confusing circumstances. They are listed here:

Poor Salaries and Not Enough JobsThe psychologists in India receive dismal salary as compared to that prevailing in other countries. In the western countries psychologists are one of the highest paid professionals in the healthcare. But compared to that Indian psychologists get very mediocre salaries. According to a report published on an online source in the U.K., the wages for clinical psychologists range from £28,313 to £37,326 per year. Senior clinical psychologists can expect to earn between £36,112 and £43,335. In the U.S., in 2009, clinical, counseling and school psychologists earned an average salary of $66,040 per year while industrial psychologists earned $83,260.(12) Psychologists who have specialized and those working in the private sector earn considerably more. In India, a psychologist earns between Rs. 60,000 to Rs. 1,200,000 depending on specialty, location and popularity. In a private hospital, a fresh clinical psychologist with an MPhil degree can draw about Rs. 30,000 a month.(12)This doesn’t seem very attractive and inspiring. One can note that there is a big disparity between the lowest to highest salaries in India ranging from Rs 60,000 to Rs 1,200,000 per year. The reason behind this is not just the experience and skills rather it depends largely on the sector in which one is employed. The higher end salaries are drawn by the psychologists employed in government mental hospitals, teaching in government universities and military services. But then they are only handful. Others employed in private settings, small hospitals, research projects or in schools account for mid range salaries. The psychologists and professional working in NGO’s or small rehabilitation centers are in the biggest numbers but they are at the bottom of the salary pyramid. Amore recent report provides somewhat skewed picture.(13)Psychologists Salaries in India by Experience:*

* By curtsey of http://www.naukrihub.com/Further it is reported that the number of female professionals in the field of psychology has outdone that of their male counterparts in India. While 87% of the clinical psychologists are women, they account for around 57% of the counseling jobs. In fact women can earn from around INR 180,000 up to around INR 443,700 in this field based on experience, job skills and other factors.(13)While if higher end of the salaries look attractive, one should notice that these are quite rare and the big disparity is quite discouraging. But the more challenging part of the story is that in India there are not many jobs for psychologists and counselors. Very few schools have a designated post for the counselor. There also they make use of a counselor by assigning him the responsibilities of a sports teacher, music teacher or a go to man in case some other specialized teacher is absent. Since there are not many options, a trained counselor is made to do everything except counseling. Same is the case with hospitals. Rarely any hospital is going to hire a psychologist and then they would expect him to take care of at least 20-30 patients a day. Reason is simple.They compare him with a usual physician who is going to attend at least 50-60 patients a day. In the research field or teaching also there are limited options. So at the end of the day the psychologists and counselors are left to compromise with a job in NGOs or in some rehabilitation centers with minimal pay.Lack of LicensingAnother challenging issue is that there are no licensing measures for psychologists. The Rehabilitation Council of India (RCI) is entrusted with the job of providing the licensing of clinical psychologists and rehabilitation psychologists only. The Rehabilitation Council of India (RCI) was set up as a registered society in 1986. On September, 1992 the RCI Act was enacted by Parliament and it became a Statutory Body on 22 June 1993. The Act was amended by Parliament in 2000 to make it more broad based. The mandate given to RCI is to regulate and monitor services given to persons with disability, to standardize syllabi and to maintain a Central Rehabilitation Register of all qualified professionals and personnel working in the field of Rehabilitation and Special Education.(14) The idea was that psychologists who are working with disabled and needing rehabilitation need to be registered with RCI. For this an MPhil in Clinical Psychology is the only option rendering other degrees and certificates meaningless. So since the advent of the RCI the confusion has increased even more. The psychologists working in other fields than rehabilitation don’t know if they need to get registered with RCI or not. RCI has not helped reduce this confusion by providing ambiguous information to the psychologists asking for clarifications. There have been voices of protest everywhere but to no avail.(15) Many psychologists in fear of these false rumors of punitive actions (if RCI certificate is not availed) began the search of some RCI certificate by taking some meaningless certificate course, totally unconnected to their actual practice. Finally in response to an RTI application RCI statedthat it has no authority to register anyone who is not claiming to be a clinical psychologist or working in the field of rehabilitation.(16) Since there is no licensing or even accepted guidelines for practicing, the employers are not sure whom they should hire. People of different skills can apply for the same job and it is quite possible that a wrong person with not desirable skills might be working there. This has resulted in a sense of confusion all around.Lack of Awareness and AccessibilityDespite development of education and growing awareness of psychological issues, the age old superstitions and reservations against psychological problems and patients are still strong. Religion and spiritual beliefs may work both as medicines and poison for mental illness. Many Indian people develop various guilt feelings as their lives are not according to the religious norms.(17) Further there is a tendency to simply ignore the mental illness or not to stick to the treatment for long enough as the psychotherapeutic treatment doesn’t seem as a traditional medical treatment. In a recent study it was found that Desire to handle the problem on one’s own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%).(18) Perceived ineffectiveness of treatment was the most commonly reported reason for treatment dropout (39.3%) followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). However Women and younger people with disorders were more likely to recognize a need for treatment.(18) If you look at the school settings, teachers in schools are not aware of even the existence of various learning problems.(19) In such a situation how would anyone expect that these problems would be brought to the attention of psychologists. On the other hand this outlines the need of employing a school counsellor in each school.ConclusionOn the basis of above argument we can conclude that psychologists and counsellors have no doubt a bright future in India but they’ll have to build the road to success by themselves. There are various challenges for them to overcome but a big population and not many people in the field provide mouth watering opportunities. In next few years of grinding hard the field of psychology and mental health professional will find a prosperous and respectful place in Indian society.References1.Aschengrau A, Seage GR., (2003). Essentials of epidemiology in public health. 3rd Edition. Pub: Jones and Bartlett, Sudbury, Massachusetts. 2.Suresh, Bada Math, Ravindra, Srinivasaraju (2010). Indian J Psychiatry; 52 (1): 95–103. 3.Lakhan, R; Ekúndayò, OT (2015). National sample survey organization survey report: An estimation of prevalence of mental illness and its association with age in India. 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How to cite this article:Agrawal, G. (2015). Psychology in India: A Career with Uncertain Opportunities. Online Journalof Multidisciplinary Research, 1(2): 1-7.